Provider Demographics
NPI:1104957034
Name:FLORENCE CRITTENTON SERVICES OF ORANGE COUNTY, INC.
Entity type:Organization
Organization Name:FLORENCE CRITTENTON SERVICES OF ORANGE COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MANFRED
Authorized Official - Middle Name:FRITZ
Authorized Official - Last Name:CZYPULL
Authorized Official - Suffix:
Authorized Official - Credentials:MIM
Authorized Official - Phone:714-680-8257
Mailing Address - Street 1:801 E CHAPMAN AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3839
Mailing Address - Country:US
Mailing Address - Phone:714-680-8265
Mailing Address - Fax:714-680-8207
Practice Address - Street 1:600 N HARBOR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832
Practice Address - Country:US
Practice Address - Phone:714-680-8265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARU 7523OtherMEDICAL SITE CERTIFICATION